O2592 NONUNIONS OF THE DISTAL TIBIA TREATED BY REAMED INTRAMEDULLARY NAILING

Abstract

Aims: Nonunions of the distal tibia are difþcult to treat due to the short distal segment, the proximity to the ankle joint and the fragile soft tissue envelope. Intramedullary nailing is an attractive solution as it avoids extensive soft tissue dissection and remains intraosseus, posing little problem for the soft tissues. The purpose of this study was to determine the efþcacy of reamed intramedullary nailing in the treatment of non-unions of the distal one-quarter of the tibia. Methods: Thirty-two patients with nonunions of the distal one-quarter of the tibia were treated by reamed, locked intramedullary nailing. Prior treatments included casting as well as intramedullary or extramedullary þxation techniques. No patient had signs of an active infection at the time of surgery. Time to union, correction of deformity and complications including infection and reoperation were examined. Results: Twenty-nine out of thirty-two patients achieved union at an average of 3.5 months after surgery. Of the remaining three, two patients united rapidly after dynamisation and one after exchange nailing. Deformity was corrected to a maximum of four degrees in all planes. Four patients had positive intraoperative culture, and only two required removal of the nail after achieving union to eradicate infection. There were no cases of chronic osteomyelitis after the procedure. Conclusions: Reamed, locked intramedullary nailing is a reliable and safe procedure in the treatment of nonunions in the distal one-quarter of the tibia. It allows for excellent correction of deformity, which is an essential component of the procedure.